Huang Yun-Ching, Liu Jui-Ming, Liu Hui-Ying, Chang Yin-Lun, Chen Chih-Shou, Ho Dong-Ru, Wu Chun-Te, Chen Miao-Fen, Wang Hung-Jen, Luo Hao-Lun
Department of Urology, Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
Cancers (Basel). 2023 Mar 20;15(6):1858. doi: 10.3390/cancers15061858.
Oncologic outcomes for pT2N0M0 upper tract urothelial carcinoma (UTUC) after nephroureterectomy are not well defined, with most previous studies focused on a heterogeneous population. Therefore, we aimed to investigate the clinical determinants of extraurinary tract recurrence and survival after radical surgery in patients with localized UTUC.
We retrospectively identified 476 patients with pT2N0M0 UTUC who underwent radical nephroureterectomy or ureterectomy between October 2002 and March 2022. To evaluate the prognostic impact, patients were divided into renal pelvic, ureteral, and both-region (renal pelvis plus synchronous ureter) groups based on tumor location. The outcomes included recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Associations were evaluated using multivariable Cox regression analyses for prognostic factors and Kaplan-Meier analyses for survival curves.
The renal pelvic, ureteral, and both-region groups consisted of 151 (31.7%), 314 (66.0%), and 11 (2.3%) patients, respectively. Kaplan-Meier analyses comparing the three tumor types showed significant differences in 5-year RFS (83.6% vs. 73.6% vs. 52.5%, = 0.013), CSS (88.6% vs. 80.7% vs. 51.0%, = 0.011), and OS (83.4% vs. 70.1% vs. 45.6%, = 0.002). Multivariable analyses showed that age >60 years, previous bladder cancer history, ureteral involvement (ureteral and both-regional groups), and positive surgical margins were significant negative prognostic factors for the studied outcomes.
Patients with pT2 UTUC and presence of ureteral involvement had more frequent disease relapse. Subsequent adjuvant therapy regimens and close follow-up in patients with negative prognostic factors are warranted despite complete pathological removal of the tumor.
肾输尿管切除术治疗pT2N0M0上尿路尿路上皮癌（UTUC）后的肿瘤学结局尚不明确，既往大多数研究关注的是异质性人群。因此，我们旨在研究局限性UTUC患者根治性手术后尿路外复发和生存的临床决定因素。
我们回顾性纳入了2002年10月至2022年3月期间接受根治性肾输尿管切除术或输尿管切除术的476例pT2N0M0 UTUC患者。为评估预后影响，根据肿瘤位置将患者分为肾盂、输尿管和双区域（肾盂加同步输尿管）组。结局指标包括无复发生存期（RFS）、癌症特异性生存期（CSS）和总生存期（OS）。使用多变量Cox回归分析评估预后因素的相关性，使用Kaplan-Meier分析绘制生存曲线。
肾盂组、输尿管组和双区域组分别有151例（31.7%）、314例（66.0%）和11例（2.3%）患者。比较三种肿瘤类型的Kaplan-Meier分析显示，5年RFS（83.6%对73.6%对52.5%，P = 0.013）、CSS（88.6%对80.7%对51.0%，P = 0.011）和OS（83.4%对70.1%对45.6%，P = 0.002）存在显著差异。多变量分析显示，年龄>60岁、既往膀胱癌病史、输尿管受累（输尿管组和双区域组）以及手术切缘阳性是所研究结局的显著不良预后因素。
pT2 UTUC且存在输尿管受累的患者疾病复发更频繁。尽管肿瘤已完全病理切除，但对于具有不良预后因素的患者，后续辅助治疗方案和密切随访是必要的。
